Inspection on 12/02/08 for Eliot House Nursing Home

This inspection was carried out on 12th February 2008.

CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Eliot House Nursing Home 16/03/10

Eliot House Nursing Home 10/04/07

Eliot House Nursing Home 19/04/06

Eliot House Nursing Home 16/01/06

Eliot House Nursing Home 09/06/05

Similar services:

Trevayler Residential Care Home

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Eliot House Nursing Home Crooked Billet Street Morton Gainsborough Lincs DN21 3AH Lead Inspector Dawn Podmore Unannounced Inspection 12th February 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Eliot House Nursing Home DS0000063148.V359412.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Eliot House Nursing Home DS0000063148.V359412.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Eliot House Nursing Home Address Crooked Billet Street Morton Gainsborough Lincs DN21 3AH 01427 617545 01427 611718 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) MPS Care Homes Ltd Karen Bowler Care Home 29 Category(ies) of Dementia (29), Mental disorder, excluding registration, with number learning disability or dementia (29), Old age, of places not falling within any other category (29) Eliot House Nursing Home DS0000063148.V359412.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered to provide personal and nursing care for service users of both sexes whose primary needs fall within the following categories: Dementia - over 55 years of age Mental Disorder, excluding learning disability or dementia - over 55 years of age Old age, not falling within any other category The maximum number of service users to be accommodated is 29. Date of last inspection 10th April 2007 Brief Description of the Service: Eliott House is a care home providing personal and nursing care for up to 29 older people all within the category of dementia or mental disorder. The home is located in the village of Morton, which is on the outskirts of Gainsborough. It is a listed building with a new extension to the rear of the property. A staircase can access the first floor or a lift is available. The home has 21 single and 4 double bedrooms. Thirteen of the rooms have toilet facilities. Parking is provided at the front of the home and additional on street parking is available. It is also close to the local bus route. There are local shops and public houses within walking distance of the care home. The home is surrounded by its own gardens, which are totally enclosed, this provides security for residents staying at the home. There are also a number of patio areas where people can sit in warm weather. The current scale of charges at this home is from £344.00 to £568.43. Additional costs are made for services such as, hairdressing, chiropody, newspapers and escorting residents to hospital etc. These are all private arrangements and the individual residents meet these costs. Information about these costs as well as the day-to-day operation of the home, including a copy of the last inspection report, is available from the manager’s office. Eliot House Nursing Home DS0000063148.V359412.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This key inspection was unannounced and took any previous information held by the Commission into account. This included the findings from the last key inspection in April 2007 and the content of the provider’s annual quality assessment (A.Q.A.A.). The main method of inspection used is called case tracking. This involved selecting three residents and tracking the care they receive through the checking of records, discussion with them, the care staff, and observation of care practices. Other documentation was also sampled. Interviews with residents, visitors and staff took place so that they could give their opinion of the care and facilities provided. Survey forms were also used to gain peoples view on the service they were receiving. Positive comments were contained in the 5 surveys returned to us. The visit was also part of a joint investigation with social services following concerns raised in a recent complaint. On the day of the visit 25 people were living at the home. What the service does well: What has improved since the last inspection? Staff training has been provided in subjects such as, induction, fire safety, customer care, safeguarding adults from abuse and basic food hygiene. This also includes all staff receiving infection control training so that they have the knowledge to keep the home, as far as possible, free from possible infectious diseases. Menus have been revised following comments made by residents in Eliot House Nursing Home DS0000063148.V359412.R01.S.doc Version 5.2 Page 6 surveys or discussions. New furniture has been purchased for communal areas and some bedrooms, and some redecoration has taken place. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Eliot House Nursing Home DS0000063148.V359412.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Eliot House Nursing Home DS0000063148.V359412.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s admission procedure includes an initial assessment, which helps to make sure that it can meet the needs of people admitted to the home. EVIDENCE: A review of all information available prior to this visit, including the content of the A.Q.A.A and records seen at the inspection in April 2007, showed that the home does not admit residents without a care needs assessment being undertaken. Prospective residents are also written to by the home confirming whether they can meet the residents care needs or not. A visitor spoken with during this visit confirmed that her partner had been visited prior to admission and that an assessment of his needs had taken place. This home does not provide intermediate care. Eliot House Nursing Home DS0000063148.V359412.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s personal care and health needs are being met by staff who understand their needs and deliver care in a respectful manner. Care plans contain sufficient details to meet people’s needs. However, they do not contain information that fully reflects people’s preferences. People are able to manage their medications themselves if they can, but if they need help staff are trained to support them with it in a safe way. EVIDENCE: Each resident had an individual plan, which contained information relating to his or her care needs. We looked at 4 care files, one of which was for a recently admitted resident. A concern raised by a relative in a recent complaint to us was regarding easy access to care records. The records we saw were easy to access and contained good detail about peoples care needs. However it was recommended that additional information be added so that they reflected the resident’s individual preferences better. For example although staff comment and records showed that residents were regularly bathed the plans did not say at what time of day best suited the resident or how often they preferred a bath. Eliot House Nursing Home DS0000063148.V359412.R01.S.doc Version 5.2 Page 10 Care plans had been evaluated monthly, but these consisted of a date and signature. It was suggested that a more meaningful evaluation should be recorded, which included any improvement or deterioration in the resident’s condition over the preceding month. This would demonstrate if the plan of care was working or not. Pressure damage was well recorded and monitored and the tissue viability nurse had been consulted regarding any areas of concern. Pressure relieving equipment, such as specialist air mattresses were also being used. Risk assessments had been carried out to identify any potential risks associated with people’s care; this included manual handling and the fitting of bedsides. The content of two risk assessments concerning pressure damage and behavioural problems was basic and would benefit from additional information. However the care plans covering these areas were very well detailed and gave staff clear guidance on how to minimise potential risks. Records and peoples comments showed that outside agencies, such as doctors, district nurses, opticians and chiropodists, visited the home regularly to meet people’s health care needs. The manager said that she was currently trying to access a regular dentist as the current one dealt with mainly emergencies. It was recommended that the arrangements for these services be recorded in better detail in residents care plans so that staff had clearer guidance. The provider’s Annual Quality Assurance Assessment (A.Q.A.A.) and the content of the last inspection report demonstrated that the home has satisfactory policies and procedures concerning the receipt, storage, administration and disposal of medications. Observation of part of the lunchtime medication administration, and a discussion with the nurse in charge, showed that medications were being handled safely. Concerns were expressed to us in a letter in December about nurse ‘potting up’ medications for care staff to give out. This was discussed with the manager and staff who said that this was not the current practice at the home. A nurse said ‘sometimes a carer may give the medication if they are feeding someone but the nurse will watch it being given’; the care staff we spoke to confirmed this. Some of the residents were unable to communicate, but those spoken with informally said that they were happy living at the home. Three visitors said that they were very happy with the way care was being delivered. They felt that people’s needs were being met to a high standard. Comments included: ‘the care is excellent’, ‘she is always kept beautifully clean and has her hair done every Monday’ and ‘I am very happy’. The staff interviewed demonstrated a good knowledge of the people they cared for. They were seen delivering care responsive to resident’s needs and preferences, as well as respecting their privacy and dignity. Eliot House Nursing Home DS0000063148.V359412.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People maintain contact with their friends and relations, who are made welcome at the home. Residents receive a nutritious, varied diet, which meets their individual preferences and health requirements. EVIDENCE: Information from the previous inspection and the AQAA showed that the home undertakes a variety of activities for residents. Activities are made available by the care staff who have an interest in promoting activities for residents. In April the activity sheets showed that stimulation provided included, gentle exercise, birthday celebrations, facials, hairdresser visits, walks in the village and sing-a-longs. One person told us, ‘mum is supported in everyway but she is never pressed to carry out any activity that she does not wish to take part in’. Visitors said that they were always made welcome at the home and that staff kept them well informed about any changes in their relatives conditions. One relative said, ‘the manager and staff pass on information regarding my mother’ and ‘contacted by telephone immediately if a problem arises’. Another said, ‘all the nursing staff are friendly and jovial, they always make visitors very welcome’. Eliot House Nursing Home DS0000063148.V359412.R01.S.doc Version 5.2 Page 12 In April the inspector had joined residents for lunch and found that the meal was hot and very tasty and that choices were available, therefore this subject was not looked at in depth during this visit. Some residents eat with the support of care staff or visiting relatives and it was noted that care is taken in ensuring the residents dignity during this process. We did look at how residents who required special diets, or were not eating a balanced diet, were assisted. Records showed that appropriate alternative diets and/or food supplements had been provided. People’s weights were being regularly monitored and doctors and specialists contacted if necessary so that peoples dietary needs were met. The AQQA stated that changes had been made to menus following consultation with residents and relatives. Surveys returned to us indicated that people were happy with the meals offered. Two people we spoke to during the visit told us, ‘the food is very nice’, ‘it’s nice because I can come and have a meal with him’ and ‘they (the residents) are well fed and looked after’. Eliot House Nursing Home DS0000063148.V359412.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are protected by clear policies and procedures; and staff who are trained and knowledgeable. EVIDENCE: The home has a complaints procedure, which is on display in the reception area and is included in the Service Users Guide. Relatives spoken with said that they knew how to make a complaint but were happy with the service provided and highlighted no concerns. Information provided by the manager showed that the home had received one complaint since the last inspection. One relative told us ‘only very minor issues raised, these have been dealt with without delay’. We have received 3 complaints since the last inspection. Concerns identified have either been previously investigated by us or/and social services or were looked at as part of this inspection. Concerns identified included the reporting of incidents at the home, staffing arrangement for one shift, medication practices, maintaining good communication with relatives, access to outside agencies, such as an optician and dentist, and the management of pressure damage. Each of these issues were looked at by us as a concern, or by social services under safeguarding adult protocols. Some issues were upheld while others were not substantiated. Details of the findings of the complaint are included in this report under the relevant section. Eliot House Nursing Home DS0000063148.V359412.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the home live in a clean, comfortable and homely environment, which offers a good standard of décor and furnishings. EVIDENCE: At the last inspection the home and the outside areas were in a good state of repair with residents rooms personalised with photographs and other memorabilia. During this inspection time was spent in communal areas on the ground floor. The rooms were airy and well decorated with no offensive odours. Visitors told us that the environment had been improved with redecoration and new furnishings. One relative said ‘I imagined that it would be smelly, but not at all, it’s lovely’. Eliot House Nursing Home DS0000063148.V359412.R01.S.doc Version 5.2 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Procedures for the recruitment of staff were robust and therefore offered protection for people living at the home. Staff have access to training and support to help them meet the needs of the people they care for. EVIDENCE: We reviewed all the information we had about the home including the AQAA, concerns we received in December, about one shift that would be a carer short, staff rotas and the findings at the inspection in April 2007. These indicated that in the main the levels of staff provided were adequate to meet people’s needs. It was however recommended that additional information be included on the staff rota so that it clearly reflects which staff are on duty at any particular time. Therefore a key should be added to clarify any codes used, for example ‘N’ for nights and the staffs status, such as Registered Nurse or care worker should be added. The manager’s hours should also be recorded clearer so they reflect when she is working office shifts. During the visit staff and visitors told us that staffing levels were satisfactory. They said, ‘there always seems more than enough staff on duty, including at weekends’, ‘they are always around when you need them’, ‘very occasionally we are short due to sickness, but we have bank staff and people will do extra hours’ and ‘levels are good, we used to have a problem with nights, but that’s sorted now’. One person who returned a survey said, ‘I have no criticism of the number of staff, all are professional and caring in their duties’. Eliot House Nursing Home DS0000063148.V359412.R01.S.doc Version 5.2 Page 16 Information available showed that the home recruits staff safely. This includes making essential checks, such as obtaining written references and a C.R.B. (Criminal Records Bureau) certificate prior to staff starting work. These are carried out to make sure that potential staff are suitable to work with vulnerable people. Records and staff comments confirmed that staff had received training in subjects such as infection control, manual handling and basic food hygiene. Information provided by the manager showed that 7 carers had completed an N.V.Q. (National Vocational Qualification) course in care and 5 others are currently undertaking the course. Staff said that they felt well supported by the manager. Eliot House Nursing Home DS0000063148.V359412.R01.S.doc Version 5.2 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is managed in the best interests of the residents. There are systems in place to ensure that the health safety and welfare needs of residents are met. EVIDENCE: The Commission undertook a fit person interview in 2006 and found the manager to be suitably qualified and has the appropriate training and experience to manage the home. Records demonstrated that the manager had taken appropriate action to address incidents at the home affecting the well being of residents, for example a medication error. The records pertaining to these incidents were well recorded, but they had not been reported to us, as they must to be. The Eliot House Nursing Home DS0000063148.V359412.R01.S.doc Version 5.2 Page 18 importance of reporting all incidents was discussed with the manager and a requirement made that incidents must be reported properly in future. During the visit the manager and staff appeared to work well together and peoples individual needs were considered throughout the day. Visitors and staff made positive comments about the way in which the manager runs the home, saying that they found her to be approachable and supportive. One person told us, ‘the general good management of the home presents a friendly environment’. The provider or his representitive is required to visit the home monthly and complete a report detailing their findings at the home and how any concerns or issues are to be addressed. Although tick box reports had been completed the content did not provide any details about what the provider found or what people said to him. It was recommended that the content of the report be expanded to include more detail of how issues at the home were being dealt with and peoples comments. This would then give a clear picture of what the provider found during each visit. Information contained in the last inspection report and in the AQAA showed that the manager had undertaken internal audits and used surveys for both residents and visitors to make sure that people were happy with the service being provided. Residents/relatives meetings had also taken place and people were encouraged to discuss any concerns if they arose. People who returned surveys said, ‘totally satisfied, can’t think of any area for improvement’ and ‘attended a next of kin meeting recently, which was also attended by the owner, good and open discussion took place’ The personal allowance records were checked at an earlier inspection and found to be satisfactory; therefore none were examined during this visit There are a range of policies and procedures available in the home to guide residents and instruct staff, including fire safety. Information collected prior to this inspection demonstrated that the routine maintenance of equipment had been carried out as required. Eliot House Nursing Home DS0000063148.V359412.R01.S.doc Version 5.2 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X 2 3 Eliot House Nursing Home DS0000063148.V359412.R01.S.doc Version 5.2 Page 20 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. OP31 37 Standard Regulation Requirement There must be a system introduced to make sure that the Commission are notified in writing about any incidents that affect the wellbeing of the people living at the home. Timescale for action 17/03/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations Care plans should provide better guidance to staff about people’s preferences and their role in supporting the residents. This should include the arrangements for visiting outside agencies, such as the dentist and optician. This would ensure that staff have access to clearer instruction about how people prefer to be supported. Staff duty rotas should have additional information about the codes used, the designation of staff and the managers supernumerary hours. The content of the provider’s monthly report should be DS0000063148.V359412.R01.S.doc Version 5.2 Page 21 2. OP27 3. OP37 Eliot House Nursing Home improved so that it adequately reflects how the home is operating and any issues that need addressing. It should also reflect what people spoken with think about the service being provided. Eliot House Nursing Home DS0000063148.V359412.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection East Midland Regional Office Unit 7 Interchange 25 Business Park Bostocks Lane Nottingham NG10 5QG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Eliot House Nursing Home DS0000063148.V359412.R01.S.doc Version 5.2 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!